"The awareness of transgender health issues has increased, but we need to provide both current and future endocrinologists with the tools to meet this growing demand," said lead study author Caroline Davidge-Pitts, MD, of the Mayo Clinic in Rochester, Minn. "We have a deficit in both our training programs and in practice."

Because of the hormone treatments that many transgender individuals receive, endocrinologists frequently are sought out by transgender patients.

"The transgender community has a disproportionate number of individuals who are uninsured and 19% have been frankly denied care by healthcare providers," Davidge-Pitts and colleagues wrote. "However, with insurance coverage expansion, care is becoming more accessible and affordable. With this increase in accessibility, it is anticipated that many patients will be seeking care under endocrinologists."

The Mayo Clinic and the Endocrine Society jointly developed a web-based survey sent to 104 endocrinology fellowship program directors and 6,992 of the society's U.S. members.

Of the 54 program director responses, 72.2% reported that they provided teaching on transgender health topics, while 93.8% indicated training in this area is important. The Accreditation Council for Graduate Medical Education does not require endocrinology programs to contain transgender-specific content.

Of 411 responses from practicing endocrinologists, almost 80% had treated a transgender patient, but a nearly identical percentage, 80.6%, reported never having received training on caring for transgender populations.

Among responders who did receive training on transgender health, 58% said it came from an endocrinology fellowship, and 52.7% reported obtaining it at meetings. Only 4% reported received instruction during medical school and 6.7% during internal medicine residency. Just under 20% received training online, 30% attended relevant lectures, and 26% received training through CME activities. One-fifth reported learning through "other" methods such as self-directed learning, experience in transgender clinics and participation in committees or development of guidelines.

Despite the low level of education exposure, clinicians still expressed being very or somewhat confident with relevant clinical definitions (77.1%), taking a history (63.3%), and prescribing hormones (64.8%).

"While almost three-quarters of endocrinology fellowship programs that responded reported providing some transgender-related education, there is still a gap between provided education and perceived importance of such education amongst program directors," the study authors wrote. "Our survey results suggest that non-hormonal aspects of transgender care are under-emphasized in fellowship program curricula."

According to Davidge-Pitts and colleagues, this suggests a need for a more patient-centered approach to transgender health education, with key barriers to that education including a lack of faculty interest or experience.

The authors suggested that all of the relevant modes of education should include more material on transgender patient management.

Additionally, the Endocrine Society is updating its 2009 Clinical Practice Guideline on gender dysphoria. The revised guidelines will provide evidence-based recommendations and best practices for treating transgender patients.

The American Association of Clinical Endocrinologists is also aware of the issue. At its annual meeting last year, the group hosted a session on "Transgender Medicine: What an Endocrinologist Should Know," in which speakers called for improved access to transgender care for patients and more comprehensive training for endocrinologists in transgender medicine.

None of the authors or commenters disclosed any relationships with industry.

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